An Open Letter to the Department of Psychiatry, American University of Beirut Medical Center

This is an open letter from a former patient. The intent of this letter is to expose the unethical treatment of patients in your department due to violation of doctor-patient confidentiality, which is especially crucial when it comes to mental health, and to urge you to take vigilance in future in enforcing confidentiality policies.

Patient information ought to be confidential and protected, except in cases where patients pose a risk to themselves or to others. Even then information should be disclosed only as needed, ie on a ‘need-to-know basis,’ as referenced on the AUBMC website.

Why then was information relating to my health and wellbeing regularly reported by my doctors to my father simply upon his asking? Why did this occur repeatedly in the five years (2007 to 2012) in which I was an adult outpatient visitor to the Department of Psychiatry? I never signed a release form permitting this. So why was my right to confidentiality routinely and progressively violated?

These are the effects of such unethical medical conduct:

1) The doctors who gave my father personal information about my life and health were unknowingly giving a violent and abusive parent weapons against his mentally ill daughter. I was held accountable in various ways for being ill and for not telling him that I was ill.

2) Since this happened from the beginning and was a recurring process, I had no reason to trust my doctors. How does a psychiatrist help a patient that has no trust in their help? I was supposed to be able to seek refuge in a medical field designed to help people like me. Instead, I was given every reason not to trust the healthcare professionals in your department to care for my health.

3) Because I had no trust for my doctors, I could not take the risk of telling them about my father’s abusive nature in attempt to get them to honor confidentiality. How did I know they wouldn’t tell him that I described him as such? The chance of that happening was extremely threatening to my emotional and physical well-being. The only avenue I could think of to get my doctors to start honoring confidentiality was so risky I could not take it. I should not have had to even consider asking for something that was my absolute right.

4) I was not able to speak to my psychiatrists about the trauma in my everyday life because it related to my father, and thus they were missing information that was crucial to treating me.

5) I had to resort to pretending I was well and lying to the doctors I could not trust, and thus not receiving adequate treatment if my symptoms happened to relapse.

In addition to the above, the psychiatrists in your department did not once question the narrative my father fed to them, in my presence, the first day I was brought to the office. They did not see me alone and ask me if what my father said was true, did not ask for my consent or confirmation of my father’s assessment of my mental capacities except superficially in his presence. In fact, they expressed agreement with my father’s assessment of my character and actions and passed moral judgments upon me and shamed me for them as I sat there. Setting aside that judging and shaming a mental health patient is possibly the most counter-productive thing to do, their doing so was based on a mere assumption. They did the most unsafe thing they possibly could: They assumed my father was honest and did not for a moment entertain the possiblity that he could be a prime manipulator. They valued that assumption over discovering the truth about and ensuring the wellbeing of their patient.

My father went with me to every visit for the first several months. Not once was I able to speak outside of his presence. I could not ask to speak to my doctors alone because he would punish me for such a request once I got home. My doctors should have made that request themselves. It was their responsibility. It was their job. By the time I started seeing them alone, I had no reason to trust them.

For years, your department caused me unspeakable damage and anguish. Although I was a highly educated and competent adult working on a graduate degree and who taught at the university level, I was treated like I had the mental competence of an infant. Even children are taken aside and asked if such-and-such event really happened.

I urge you to regulate and enforce doctor-patient confidentiality in your department. I urge you to allow and require that patients accompanied by other people see their doctors alone and speak for themselves. I urge you to honor the Hippocratic Oath and your own policies. I urge you to make sure that nothing like this ever happens again.

I also feel compelled to make the point that the above behavior is entirely consistent with cultural norms and ideals privileging paternal access to information and decision-making as some perceived right over patient personal autonomy, especially when it comes to women and female children. I urge you as a department to refuse to condone behavior that values Lebanon’s cultural norms of patriarchy, especially when they contribute to abuse and misogyny, over your medical duties. Should your doctors personally subscribe to patriarchal norms in their private lives, that is their business. If and when these biases leak into their medical practice, this becomes wholly unacceptable and is an indication that they do not have the reservation and judgment fit to be mental health care providers.

I have since moved to the United States, and my father’s attempts at control followed me to my new psychiatrist’s office. Except this time, his phone calls never got past the secretary, his emails were deleted unanswered, and his spying and stalking was met with horror and a sense of protectiveness by my psychiatrist and therapist.

Never again will I accept anything less than that. I hope you can maintain the same standards for your practice.

This shit happens all the time in Lebanon!!! Do you think you can even hold them accountable for breaching confidentiality just because they “assumed” it was the right thing to do! Intentionally or unintentionally… for the patients, they don’t care, they just want to kick the hell out of their asses and show them who’s boss of their lives!
I personally think patients who have been “betrayed” shouldn’t sue these unprofessional & unethical so called Doctors/Psychotherapists, I think the best weapon is the power of word and one’s reputation! Some may do this because they “assume” it is the right thing and other do this because of arrogance! Trust me, purely arrogance… that’s when can knock them down with your own means!!
Reputation People… Reputation!! State the name of that asshole and ruin his damn reputation!

This post is really bitter sweet for me. I really abhor what has been done, but I am also relieved someone is speaking about it. I have recently consulted with my surrounding about seeking psychiatric help in Lebanon, and AUBMC was off the table for that reason. I needed the help, but even the most reputable teaching hospital in Lebanon was not recommended. Confirming these concerns is both horrible and eye-opening. Thank you for speaking up, you are a very brave person!

First of all I salute you for your courage to talk about mental illness, I am majoring in Psychology at AUB and people already assume that I’m mentally unstable or I will be unstable after finishing my degree. Psychiatry is a taboo in our society although everyone needs a psychologist in their lives.

Second, I don’t think it’s AUBMC’s fault if the doctor is not doing what he is supposed to do, which is keeping his mouth shut, but the only reference you have is AUH so I understand you.

AUBMC is certainly responsible if only out of sheer negligence, which is also a form of medical misconduct. Even if they are not actively enabling by turning a blind eye to a phenomenon they know is happening, they are at the very least not taking the requisite regulatory steps to ensure confidentiality and other ethical codes are adhered to. This is the minimum requirement of an institution with official policies.

Also, I’d ask you to be a careful reader. The letter does not cast blame to the institution but to the doctors and clearly its intention is not to say ‘hey you’re letting this happen and you suck’ but rather to say ‘hey this is happening and I urge you take measures to fix it’

It’s addressed to the department that employs these doctors for that purpose. They are the authority that can actually DO something about it.

Btw even if you were mentally unstable, what of it? A psychologist of all people should know not to stigmatize mental illness.

i think you should give out names of doctors, that is the only thing that matters to them and that might make them consider doing the right thing… besides that, all academic institutions that have a psychiatrist on their payroll in lebanon, have them for the wrong reasons. some schools or universities use the psychiatrist to spy on the kids, like who’s doing drugs, who has a “liberated” mind that must be disciplined, who’s sexually active, etc… what you’ve gone through was awful, but i have a feeling that you’re determined on cleaning out this mess. just know that if u ever came public about this matter you will have friends that want the same thing as you.

How retarded! I hope you can relinquish your anger some day and get your fair pay back. Have the peace you deserve. I guess you’re moving on. Still someone should give them a beating, everything goes unaccounted for.

Unfortunately, HIPAA laws are not respected or practiced in Lebanon. I know this from experience with my medical doctors when I lived there as well. you don’t learn the value of health information and privacy until you experience it firsthand in countries outside of Lebanon. I hope this raises awareness about the lack of privacy and respect that exists between medical/mental health providers and their patients in Lebanon. I wonder if the US can influence them in any way since they are funded by the US?

A friend of mine went to a psychiatrist at AUBMC for issues related to her sexuality.
The next day, everybody was calling her Lesbian in the university.
Another friend was having a sex change surgery at AUBMC. While in the cafeteria, I overheard a lot of people talking about a trans woman having surgery, and they weren’t talking nice things of course.
AUBMC is full of unprofessional gossipy people.

Reading this all I could think is… “So I wasn’t imagining it all!”
I was diagnosed with anxiety back when I was at AUB… I went for counselling but from the first session I could sense the irony and judgement in the councillor’s tone.. He was not listening of trying to dig deaper though I had had few major traumas. He couldn’t have got in and desperately needing help. I obviously didn’t go anymore…I couldn’t go anywhere outside AUB as my family woulda found out & that was something I just couldn’t allow to happen.
The way he was OFFERING solutions, judging, and making me feel like I just want attention.
I obviously struggled during my university years as my problems were untreated and it affected both my education and family life… I didn’t always make the best decisions for my future.
I have since moved to the UK and received treatment here for what had developed into depression and panick attacks.
I also know of an AUB young man who was being treated for depression by the same department and committed suicide… Not saying it’s their fault but if he was treated the way the writer above or I was then I don’t think that would have helped him.
Lessons should be learnt by the psychiatric/ counselling department at AUB… Mistakes like these can be in some cases fatal!

Hello. I cried so much reading this. I hope you find what you are looking for. It really disturbs me to read how your case was handled. I am very sorry but I support you whoever you are and wherever you are.

This post got my blood boiling. I don’t know why you weren’t spoken to separately from your dad as they did for me at AUH, and I certainly hope it’s not because you’re female. Eitherway, for whatever reason it was, whoever was involved in your treatment should not only be punished for breaking patient doctor confidentiality, but should also face a malpractice suit for all the harm he/she may have caused you.
I’m glad you are getting better treatment and you definitely sound like you’re doing better, and I want to salute and thank you for digging back into your past to shed some light onto the situation here in Lebanon with regards to mental health, for your experience is one of many negative experiences people who require psychiatric help go through.
Also, thumbs up to this blog, i really like it

I’m so glad you finally had the courage and means to travel to the states and become independent and were able to receive the care you deserved. I’m so glad that you posted this letter, I hope it makes a difference because confidentiality is absolutely crucial, and no one, especially psychiatrists, should take anything for granted about a patient.

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Religion – or so the age-old hypothesis goes – is therefor a necessary glue for keeping society together. And conversely, secularism is a danger to societal well-being. For if people turn away from God and stop being religious, then crime will go up, corruption will increase, perversion will percolate, decency will diminish, and all manifestations of misery and malfeasance will predominate.
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http://time.com/3728102/iraq-isis-takrit/?xid=IFT-Section
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In most of Britain, these messages from Cage’s parallel universe were received with shock and contempt. But the unfortunate truth is that they have significant traction with parts of its target audience.">

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http://english.ahram.org.eg/NewsContent/1/64/124123/Egypt/Politics-/BREAKING-Egyptian-court-rules-Hamas-a-terrorist-or.aspx
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